Go ahead and fix the Affordable Care Act, but don't repeal it

As policymakers in Washington look to make major changes in health care policy and financing, the potential impact on the American people and on providers cannot be overstated: Repealing the Affordable Care Act without simultaneously enacting a replacement that provides viable and affordable options to those covered will result in significant instability in our health care system that would increase the number of uninsured patients, reduce their access to quality health care and drive up costs for providers and consumers of health care alike.

President Donald Trump's executive order on Jan. 20 instructing federal agencies to "waive, defer, grant exemptions from or delay" any part of the ACA that imposes a financial or regulatory burden is creating unease in the insurance marketplace and among patients and providers. In the absence of specifics, key actors in the health care system are considering which aspects of the ACA may be repealed and when. In a health care system as complicated as ours, it is critical that all aspects of a "repeal and replace" plan be clearly outlined concurrently. Such transparency will serve all parties well by ensuring that access, cost and affordability issues are fully understood and unintended consequences are avoided.

The central focus of the ACA, aka Obamacare, was to increase access to health care insurance; an estimated 22 million previously uninsured Americans now have health insurance. In Illinois, approximately 600,000 residents are covered as the result of Medicaid expansion, and more than 300,000 purchased subsidized coverage on the exchange. The positive personal impact of gaining access to medical care to prevent and treat disease cannot be overestimated. Extending Medicaid insurance to people who previously did not qualify was a critical element in reducing the number of uninsured, and this occurred in 31 states, including Illinois, as well as the District of Columbia.

Medicaid is a joint federal-state health care program that provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. The program touches people of all ages and races throughout the country, in rural and big-city America alike. According to the Kaiser Family Foundation, 42 percent of non-elderly Medicaid recipients are white, 19 percent are black, and 31 percent are Hispanic. Medicaid is the primary national payer for children, adults and seniors who need long-term care services as a result of disabling conditions and chronic illnesses. Eliminating the Medicaid expansion of the ACA would leave millions of people uninsured.

Similarly, eliminating employer and individual mandates to provide and obtain health care insurance and eliminating the financial subsidies to help people purchase insurance on the exchanges would significantly reduce the number of insured, particularly young, relatively healthy people who contribute to the financial stability of the system. These actions would destabilize and undercut the viability of the health care system. Insurance companies would limit or eliminate the products they offer and exit some markets.

NEEDS REPAIR

There is no doubt the ACA has significant flaws. The recent increases in health care premiums have made the insurance exchanges unaffordable for many, and health insurance companies have withdrawn from many markets, thereby limiting choice and access for people in need. Marked increases in deductibles and co-payments are imposing a greater financial burden that many find unsustainable. It is essential that these and other problems be addressed to improve the system.

The University of Chicago Medical Center is one of approximately 400 teaching hospitals across the country. Academic medical centers are responsible not just for patient care but also for conducting cutting-edge research that saves lives and improves patient outcomes, and training the physicians and other health care professionals on which the future of medicine depends. Our hospitals particularly serve the most vulnerable and seriously ill patients.

Through the Association of American Medical Colleges, the nation's medical schools and teaching hospitals have advocated for a number of fundamental principles that should underlie any changes in our health care system. They include the following:

High-quality, affordable health insurance should be available to all.

Programs to support the health care safety net must be maintained at least at current levels until other affordable mechanisms are in place

Payments to health care providers, including physicians and hospitals, must be sufficient to ensure continued service to patients.

Health care spending must be constrained through research and innovation that develop more efficient ways to deliver health care.

If we follow these principles, we believe it will be possible to develop mechanisms to address the limitations of the current system and make progress toward the goal of providing access to health care for all Americans. It is only fair that all Americans benefit from the remarkable advances in medical care that can improve access to health care and prolong the lives of all of our citizens.

Dr. Kenneth Polonsky is dean of the University of Chicago's Division of the Biological Sciences and Pritzker School of Medicine, as well as executive vice president of the University of Chicago Medicine.